Showing papers by "David Hammond published in 2009"

Impact of graphic and text warnings on cigarette packs: findings from four countries over five years

Abstract: Objectives: To examine the impact of health warnings on smokers by comparing the short-term impact of new graphic (2006) Australian warnings with: (i) earlier (2003) United Kingdom larger text-based warnings; (ii) and Canadian graphic warnings (late 2000); and also to extend our understanding of warning wear-out. Methods: The International Tobacco Control Policy Evaluation Survey (ITC Project) follows prospective cohorts (with replenishment) of adult smokers annually (five waves: 2002–2006), in Canada, United States, UK and Australia (around 2000 per country per wave; total n = 17 773). Measures were of pack warning salience (reading and noticing); cognitive responses (thoughts of harm and quitting); and two behavioural responses: forgoing cigarettes and avoiding the warnings. Results: All four indicators of impact increased markedly among Australian smokers following the introduction of graphic warnings. Controlling for date of introduction, they stimulated more cognitive responses than the UK (textonly) changes, and were avoided more, did not significantly increase forgoing cigarettes, but were read and noticed less. The findings also extend previous work showing partial wear-out of both graphic and text-only warnings, but the Canadian warnings have more sustained effects than UK ones. Conclusions: Australia’s new health warnings increased reactions that are prospectively predictive of cessation activity. Warning size increases warning effectiveness and graphic warnings may be superior to text-based warnings. While there is partial wear-out in the initial impact associated with all warnings, stronger warnings tend to sustain their effects for longer. These findings support arguments for governments to exceed minimum FCTC requirements on warnings.

How reactions to cigarette packet health warnings influence quitting: findings from the ITC Four-Country survey.

Abstract: Objectives To examine prospectively the impact of health warnings on quitting activity. Design Five waves (2002- 06) of a cohort survey where reactions to health warnings at one survey wave are used to predict cessation activity at the next wave, controlling for country (proxy for warning differences) and other factors. These analyses were replicated on four wave-to-wave transitions.Settingandparticipants Smokers from Australia, Canada, the United Kingdom and the United States. Samples were waves 1-2: n = 6525; waves 2-3: n = 5257; waves 3-4: n = 4439; and waves 4-5: n = 3993.Measures Warning salience, cognitive responses (thoughts of harm and of quitting), forgoing of cigarettes and avoidance of warnings were examined as predictors of quit attempts, and of quitting success among those who tried (1 month sustained abstinence), replicated across four wave-to-wave transitions. Results All four responses to warnings were independently predictive of quitting activity in bivariate analyses. In multivariate analyses, both forgoing cigarettes and cognitive responses to the warnings predicted prospectively making quit attempts in all repli- cations. However, avoiding warnings did not add predictive value consistently, and there was no consistent pattern for warning salience. There were no interactions by country. Some, but not all, the effects were mediated by quitting intentions. There were no consistent effects on quit success.Conclusions This study adds to the evidence that forgoing cigarettes as a result of noticing warnings and quit-related cognitive reactions to warnings are consistent prospective predictors of making quit attempts. This work strengthens the evidence base for governments to go beyond the Framework Convention on Tobacco Control to mandate health warnings on tobacco products that stimulate the highest possible levels of these reactions.

The impact of pictures on the effectiveness of tobacco warnings

Abstract: Cigarette packages in most countries carry a health warning; however, the position, size and general strength of these warnings vary considerably across jurisdictions.1 Article 11 of the WHO Framework Convention on Tobacco Control (FCTC) and the Article 11 Guidelines adopted at the Third Conference of the Parties in November 2008 have put the spotlight on the inclusion of pictures on tobacco package health warnings. Beginning with Canada in 2001, 28 countries have introduced pictorial warnings and many other countries are in the process of drafting regulations for pictorial warnings (Box 1 and Box 2). This paper presents a brief review of the research studies that support pictorial warnings, reviewed in greater depth by Hammond1 and by the International Tobacco Control (ITC) Policy Evaluation Project.2

Cigarette pack design and perceptions of risk among UK adults and youth

Abstract: Background: It is illegal in the EU for tobacco packaging to suggest that some cigarettes are safer than others. This study examined consumer perceptions of cigarette packs in the UK, including perceptions of ‘plain packaging’, in which colour and other design elements are removed, whilst retaining the brand name. Methods: 516 adult smokers and 806 youth aged 11–17 participated in an online survey. Participants were asked to compare pairs of cigarette packs on five measures: taste, tar delivery, health risk, attractiveness and either ease of quitting (adult smokers) or brand they would choose if trying smoking (youth). Results: Adults and youth were significantly more likely to rate packs with the terms ‘smooth’, ‘silver’ and ‘gold’ as lower tar, lower health risk and either easier to quit smoking (adults) or their choice of pack if trying smoking (youth). For example, more than half of adults and youth reported that brands labelled as ‘smooth’ were less harmful compared with the ‘regular’ variety. The colour of packs was also associated with perceptions of risk and brand appeal: compared with Marlboro packs with a red logo, Marlboro packs with a gold logo were rated as lower health risk by 53% and easier to quit by 31% of adult smokers. Plain packs significantly reduced false beliefs about health risk and ease of quitting, and were rated as significantly less attractive and appealing to youth for trying smoking. Conclusions: Current regulations have failed to remove potentially misleading information from tobacco packaging. Removing colours from packs (plain packaging), as well as terms such as ‘smooth’ ‘gold’ and ‘silver’ would significantly reduce false beliefs and increase compliance with existing legislation.

The impact of cigarette package design on perceptions of risk

Abstract: Background More than 40 countries have laws prohibiting misleading information from tobacco packages, including the words ‘light’, ‘mild’ and ‘low-tar’. Little is known about the extent to which other words and package designs prove misleading to consumers. Methods A mall-intercept study was conducted with adult smokers (n ¼ 312) and non-smokers (n ¼ 291) in Ontario, Canada. Participants viewed pairs of cigarette packages that differed along a single attribute and completed ratings of perceived taste, tar delivery and health risk. Results Respondents were significantly more likely to rate packages with the terms ‘light’, ‘mild’, ‘smooth’ and ‘silver’ as having a smoother taste, delivering less tar and lower health risk compared with ‘regular’ and ‘full flavor’ brands. Respondents also rated packages with lighter colors and a picture of a filter as significantly more likely to taste smooth, deliver less tar and lower risk. Smokers were significantly more likely than nonsmokers to perceive brands as having a lower health risk, while smokers of light and mild cigarettes were significantly more likely than other smokers to perceive brands as smoother and reducing risk. Perceptions of taste were significantly associated with perceptions of tar level and risk.

Smokers with financial stress are more likely to want to quit but less likely to try or succeed: findings from the International Tobacco Control (ITC) Four Country Survey.

Abstract: Objective To examine the association of financial stress with interest in quitting smoking, making a quit attempt and quit success. Design and participants The analysis used data from 4984 smokers who participated in waves 4 and 5 (2005‐07)of theInternationalTobaccoControl(ITC)FourCountrySurvey,aprospectivestudyof acohortof smokers in the United States, Canada, the United Kingdom and Australia. Measurement The outcomes were interest in quitting at wave 4, making a quit attempt and quit success at wave 5. The main predictor was financial stress at wave 4: ‘. . . because of a shortage of money, were you unable to pay any important bills on time, such as electricity, telephone or rent bills?’. Additional socio-demographic and smoking-related covariates were also examined. Findings Smokers with financial stress were more likely than others to have an interest in quitting at baseline [odds ratio (OR): 1.63;95%confidenceinterval(CI):1.22‐2.19],butwerelesslikelytohavemadeaquitattemptatfollow-up(OR:0.74; 95% CI: 0.57‐0.96). Among those who made a quit attempt,financial stress was associated with a lower probability of abstinence at follow-up (OR: 0.53; 95% CI: 0.33‐0.87). Conclusions Cessation treatment efforts should consider assessing routinely the financial stress of their clients and providing additional counseling and resources for smokers who experience financial stress. Social policies that provide a safety net for people who might otherwise face severe financial problems, such as not being able to pay for rent or food, may have a favorable impact on cessation rates.

Smokers' responses toward cigarette pack warning labels in predicting quit intention, stage of change, and self-efficacy

Abstract: INTRODUCTION This paper is concerned with the effects of cigarette pack warning labels on quitting intentions. We examined whether different responses among smokers toward cigarette pack warning labels could predict quit intentions and self-efficacy in quitting. Variables studied were "noticing warning labels during last month," "reading or looking closely at warning labels," "avoiding looking at labels during last month," "thinking about health risks of smoking because of the warning labels, "more likely to quit because of the warning labels," and "stopping from having a cigarette when about to smoke one because of the labels." METHODS A total of 2,006 adult smokers in Malaysia were surveyed in face-to-face interviews using a standardized questionnaire. Of those, 1,919 male smokers were included in the analyses. RESULTS The responses "more likely to quit because of the warning labels" and "stopped from having a cigarette when about to smoke one" significantly predicted all stages of change and self-efficacy, independent of the other measures. In addition, thinking about the health risks and reading the warnings more often added extra predictive capacity but only in the early stages of contemplating change. DISCUSSION Less intense processing of the information may be important in initiating thoughts, but cognitions about quitting and foregoing cigarettes are the key mechanisms by which warnings stimulate quitting intentions and help smokers feel capable of succeeding. Malaysian smokers appear to respond to warnings in ways comparable with those from developed countries.

The impact of changing nicotine replacement therapy licensing laws in the United Kingdom: findings from the International Tobacco Control Four Country Survey.

Abstract: Aim To evaluate the impact of a new licence for some nicotine replacement therapy products (NRT) for cutting down to stop (CDTS) on changes in the pattern of NRT use. Design Quasi-experimental design comparing changes in NRT use across two waves of a population-based, replenished-panel, telephone survey conducted before and after the introduction of new licensing laws in the United Kingdom with changes in NRT use in three comparison countries (Australia, Canada and United States) without a licensing change. Participants A total of 7386 and 7013 smokers and recent ex-smokers participating in the 2004 and/or 2006/7 survey. Measurements Data were collected on demographic and smoking characteristics as well as NRT use and access. In order to account for interdependence resulting from some participants being present in both waves, generalized estimation equations with an exchangeable correlation matrix were used to assess within-country changes and linear and logistic regressions to assess between- country differences in adjusted analyses.Findings NRT use was more prevalent in the United Kingdom and increased acrosswavesinallcountriesbutnowave ¥ countryinteractionwasobserved.Therewasnoevidencethatthelicensing changeincreasedtheprevalenceof CDTSortheuseof NRT(irrespectiveof howitwasaccessed)forCDTSintheUnited Kingdom relative to comparison countries. There was also no evidence for a change in concurrent smoking and NRT use among smokers not attempting to stop in the United Kingdom relative to comparison countries. Conclusion The addition of the CDTS licence for some NRT products in the United Kingdom appears to have had very limited, if any, impact on NRT use in the first year after the licence change.